Cone Health Nursing Annual Report 2014

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nurse i am a

2014 Nursing Annual Report

Letter from Our Chief Nursing Officer 3 Transformational Leadership 4 Structural Empowerment 6 Exemplary Professional Practice 11 New Knowledge, Innovations and Improvements 17 Our Nurse Executives 20 About Cone Health 22

role models we are

2

Letter from our Chief Nursing Officer After nearly a year of gathering and creating 2,000 plus pages of documentation weighing 48 pounds, and hosting a threeday site visit in June from the American Nurses Credentialing Center Magnet Recognition Program®, the call came on Tuesday, Aug. 19 at 9:30 a.m. It was official. Cone Health received Magnet designation for the third time, becoming one of only three health systems in North Carolina to achieve this status.

Deb Zimmerman, chair of the Commission on Magnet, made the announcement as party horns blew, noisemakers blared and several hundred Cone Health nurses cheered.

Deb said that the Commission on Magnet was impressed with “your entire organization and your great expansion where you provide care over such a wide geographic area.” She cited the myriad of accreditations and quality awards Cone Health has received in many different service lines and health disciplines as examples of the “absolutely wonderful work that you have underway.”

“You are doing amazing work in North Carolina,” Deb said. “Congratulations, everybody.”

Congratulations, indeed. I can’t thank and commend this exemplary nursing team enough for all they do day in and day out that results in Magnet designation and other noteworthy commendations, as well as patient care of the highest quality.

Attaining Magnet redesignation helps position us for the future, demonstrating that our nurses are proactive in their efforts to improve practice, contribute to the body of nursing research and innovate. Magnet is the epitome of teamwork and perseverance, traits that also make for a great nurse and form the foundation for great patient care. These are traits that Cone Health nurses have in abundance. I am truly privileged to work with such a great team.

Sincerely,

There were six areas in which Cone Health is “truly exemplary and a role model for all magnet organizations.” They are: 1. Cone Health is a world-class organization in ensuring open communications, particularly in the manner in which leaders guide transitions during periods of planned and unplanned change. Deb specifically cited the listening and learning opportunities that give rise to dialogue between those leading the organization and those providing patient care.

2. Cone Health’s educational programs for nurses are exceptional. The new graduate nurse academy has played a significant role in Cone Health achieving a retention rate of 92 percent for new nurses, a far greater rate than the national average.

3. Cone Health is a role model for establishing partnerships, such as the Congregational Nurse Program, to address health care needs in the community.

4. Cone Health is exceptional in the way that nurses assume leadership roles in interdisciplinary collaborations such as the manner in which sickle cell patients and those newly diagnosed with diabetes receive multidisciplinary care.

5. Cone Health has expertise in providing interdisciplinary collaboration across multiple settings in the continuum of care. For example, the care that is provided to stroke patients across three Emergency Departments helped Cone Health outperform National Stroke Association targets.

6. In so many areas, innovation is vibrant at Cone Health. Deb specifically cited the Mother-Baby Unit for innovatively helping new moms allay their fears about their ability to breastfeed.

Theresa M. Brodrick, PhD, RN, CNA Executive Vice President and Chief Nursing Officer

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Transformational Leadership Transformational leaders possess the ability to stimulate and inspire others while developing their own leadership capacity. The quality of nursing leadership across the Cone Health network guides and enriches patient care and outcomes from the board room to the bedside.

Trustee Inez Tuck Named to Great 100

a three-year term. She is dean of the school of nursing at North Carolina A&T State University. She earned her Bachelor of Science degree in nursing at North Carolina A&T and a Doctorate in Child Development/Family Relations from the University of North Carolina at Greensboro. As a Great 100 nurse she joins colleagues from across North Carolina who demonstrate excellence in practice and commitment to their profession.

Inez Tuck, PhD, RN, a member of the Cone Health Board of Trustees, was honored in 2014 as a Great 100 Nurse. Tuck was named to the Board in 2013 to serve

The Great 100 Inc. is a grassroots peer recognition organization honoring the nursing profession in North Carolina by recognizing nursing excellence and providing scholarships for nursing education. Begun in 1989, the Great 100 has awarded $556,000 in nursing scholarships and recognized 2,600 registered nurses from diverse practice settings since its inception.

The 26 Great 100 nurses from Cone Health included clinical nurses, educators and leaders from across the network.

Great 100 Nurses from Cone Health

30 25 20 15

23

26

26

2013

2014

18

10 5 2011

2012

Row 1: Anita Sowder, RN; Clarissa Staten, RN; Marge Lessard, RN; Shannon Love, RN; Wendy Hicks, RN; Rachel Fountain, RN. Row 2: Danyel Johnson, RN; Julie Eastwood, RN; Barbara Akins, RN; Pam Hicks, RN; Jill Moore, RN; Gina Dixon, RN. Row 3: Laura Yontz, RN; Vanessa Tobey, RN; Marlene Yates, RN; Cameron Carlton, RN; Heidi Brown, RN; Diane Bell, RN. Row 4: Gabe Santanella, RN; Donna Coley, RN; Anne Shaver, RN; Debra Anderson, RN; Pamela Garman, RN; Dawn Whitmire, RN; Paul Summerell, RN; Annie Hodges, RN. 4

collaborators we are

Osborne Named Nurse Academy Fellow Annette Osborne, RN, MSN, vice president, Nursing/Patient Services, Moses Cone Hospital, was selected to participate in the Health Management Academy for Nurse Executives. The two-year program expands leadership development skills for high-potential nursing executives. The program is a collaborative effort between GE Healthcare, a corporate partner, and The Academy, a knowledgebased company providing independent research and advisory systems exclusively for large integrated health systems, and prominent health and medical technology companies. The first class of Academy Nursing Fellows graduated in September 2013.

Being selected is a testament to the exceptional leadership Osborne brings to the organization, as well as the opportunities for growth in leadership that exist at Cone Health. Osborne began her employment in the network in 1988 as a Nurse Tech. She has moved from the bedside through numerous leadership positions, assuming her current position in 2013.

Fencl Named Outstanding Student by University of Alabama Jennifer Zinn Fencl, DNP, clinical nurse specialist for Operative Services, received her Doctor of Nursing Practice from the University of Alabama in 2014. Fencl’s capstone project, “Examining Neurosurgical Site Infections,” gained attention from the program faculty, and she was invited to share her project at the annual DNP Intensive session held at the University each spring.

Upon graduation, Fencl received the Marietta P. Stanton Outstanding DNP Student of the Year award from the University. She remains committed to improving nursing care in clinical practice and has gained national acclaim for a number of her operative services initiatives.

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Structural Empowerment

Congregational Nurse Program Expands, Serves The Congregational Nurse program, established in 1998, has grown from affiliation with 10 congregations in the year 2000 to having established partnerships with 75 congregations or faith communities in Guilford County, including 15 religious affiliations, in 2013. In 2014, the Cone Health Congregational Nurse Program expanded yet again, this time growing its service area to include Rockingham County, thanks to a grant from the Kate B. Reynolds Charitable Trust.

During this year, the Rockingham County program has increased primary care referrals for homeless and Hispanic populations dramatically. Preventive services and supportive activities, as well as resource procurement provided by this program and its nurses, benefitted the residents of Rockingham County.

Carolyn O’Brien, RN, at the United Montagnard Church.

The work of congregational health nursing results in improved health care for our counties’ populations, as well as savings to the community. In 2014, an estimated $847,000 in health care was provided to residents of Guilford County.

The goal of congregational health nursing is to meet individuals in trusted community settings to help improve health outcomes and break down barriers to care.

Outcomes of Rockingham County Congregational Nurse Program Flu Vaccines Given

205

Rides to Medical Appointments

110

Clients Provided with Free Medication

Patricia Settle, RN, at Willow Oaks Community Center.

41

Percent Increase in Primary Care Referrals in 2014

700

632%

600 500 400 300

Wanda Martin, RN, at the Salvation Army.

285%

200 100 Homeless Population

6

Hispanic Population

pioneers we are

learners we are

RN Educational Advancement Program Grows The R.E.A.C.H. (RN Educational Advancement for Cone Health) Scholarship Loan program, established in 2011 by Cone Health nursing leaders, provides up to $6,000 for each qualifying nurse who pursues higher nursing education.

Since the program’s inception, nearly 300 nurses have participated, with 58 of them having received their BSN, MSN or DNP degrees.

Program participation continues to expand, with the program participant rate increasing by 47 percent from 2013 to 2014.

More R.E.A.C.H. participants drive the need for creative fundraising.

Among the ranks of donors are Cone Health employees, physicians and community leaders. The Office of Fund Development spearheaded a campaign to raise funds for the program.

This year, an online store to offer Cone Health nursing merchandise was launched. Proceeds from the sales of items go into the R.E.A.C.H. fund. Launched during National Nurses Week 2014, the store carries badge holders, beach towels, hot and cold beverage containers, clothing and more.

Cone Health initiated the R.E.A.C.H. program to help nurses return to school for nursing degrees in response to the Institute of Medicine recommendation that by the year 2020, 80 percent of nurses will be prepared at the BSN, MSN or doctorate level. The complement of Cone Health BSN nurses has grown steadily toward that goal.

2014 RN Educational Advancement Program Participants

Active Graduates Applications Degrees Students Working in Progress Total

RN to BSN Cohorts Continue on Cone Health Campuses Through an informal survey, Theresa Brodrick, PhD, RN, CNA, chief nursing officer, identified three key barriers for nurses who want to further their nursing education: cost, fear and convenience. The barrier of cost is addressed through the R.E.A.C.H. (RN Educational Advancement for Cone Health) Scholarship Loan program and the network’s tuition reimbursement policies. To address fear and convenience, university cohorts located on Cone Health hospital campuses were established, and the first classes began in 2013.

University of North Carolina at Greensboro, Winston Salem State University and the North Carolina A&T State University schools of nursing offer RN to BSN courses on the Moses Cone Hospital and Alamance Regional Medical Center campuses. The programs use a blend of independent learning activities, web-based activities and traditional instructional strategies, allowing registered nurses to complete required courses within two years.

In 2014, the programs continued to enroll participants. Twelve students graduated in 2014, four from Alamance Regional Medical Center.

Percentage of Cone Health Nurses with BSN Degrees or Highter

80 70 60

Percent

50 40

BSN

100

39

13

152

58.0%

MSN

76

18

5

99

37.8%

DNP

9

1

0

10

3.8%

PhD

1

0

0

1

0.4%

186

58

18

262

67%

70.3%

59%

30 28.6% 20 10 2011

2012

2013

2014

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Structural Empowerment

Shared Governance Councils Provide a Vibrant Structure for Nursing Decision Making The first Tuesday of every month, in the Women’s Hospital classrooms, the largest gathering of clinical nurses convenes in the system-wide Joint Service Practice Quality Council (JSPQC) meeting. The group is comprised of all the Unit Shared Governance Council chairs, and forms the forum for communicating and making decisions about nursing clinical practice across the system.

Each department’s Shared Governance Council representative attends the monthly meeting to discuss, coordinate and decide nursing clinical practice issues across all clinical settings.

Representatives from the following departments are included: • Emergency departments • Ambulatory area • Behavioral health settings • Operative service areas • Medical/surgical areas • ICU departments • Women’s health • Pediatric areas

In 2014, Alamance Regional Medical Center representatives were included in the forum.

short- and long-term strategies, one of which was to use an existing structure involving admission nurses.

To ensure the large group has the most potential as an efficient working group, members are required to go through an orientation to the Council and attend with their department leaders.

This activity educates and standardizes the expectations for this elite group of nurses, ensuring their maximum effectiveness as they influence the culture for nursing practice at Cone Health.

This effective Shared Governance Council also took on the challenge of participation for the 2014 annual RN Survey. Utilizing the same mechanism – creative identification of strategies through the use of the Shared Governance process and communication with constituents – the Council created the engine, fueled by clinical nurses, to drive this process.

This year, one of the activities of the Council focused on the implementation of MyChart, the electronic patient interface and communication tool.

Department reps gathered feedback from constituents on their units on ways to increase patient enrollment in MyChart. The feedback led to

Projected participation rates were expected to be lower than previous years because of necessary decisions made in the face of the turbulent health care climate. Despite a challenging year, in 2014, Cone Health enjoyed its highest system-wide participation rate in the last three years and surpassed national benchmarks for all nursing goals set for the year.

MyChart Enrollment

35 29%

25 20 15 10

12%

5 Dec 2013

8

Planning & Implementation

Percent of Patients

30

Jan-Feb 2014

20%

23% 24%

21%

15% 16% 16%

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sept 2014

Oct 2014

NDNQI 2014 Survey Results by Nursing Goals

Actual Mean

5

4.65

4.5

Scores

4 3.5

3.78

3.58

4.51

4.43

4.66 4.25

4.5

3.58 3.53

3 2.5 2 1.5 1 Decision Making

2014 Nursing Goal

Perceived Quality of Care

Participation in Hospital Affairs

Nursing Management

Nursing Staff Adjustment from Shift to Shift

Foundations for Quality of Care

Nursing Manager Ability, Leadership and Support

2014 NDNQI Decision Making RN Survey

Perceived Quality of Care

Nursing Management

Actual

Actual

Mean

Mean

Actual

RN to MD Interaction

Staffing and Resource Adequacy

Collegial RN to MD Relationships

Nursing Staff Adjustment RN to MD from Shift to Shift Interaction

Mean

Actual

Mean

Actual

Mean

Moses Cone Benchmark: All Hospitals

3.64 3.58

3.46 3.53

4.63 4.51

4.28 4.25

4.62 4.53

Wesley Long Benchmark: All Hospital

3.69 3.58

3.58 3.53

4.64 4.51

4.44 4.25

4.57 4.53

Women’s Benchmark: All Hospitals

3.98 3.58

3.67 3.53

4.76 4.51

4.60 4.25

4.74 4.53

Annie Penn Benchmark: All Hospitals

4.38 3.58

3.83 3.53

5.21 4.51

4.99 4.25

5.07 4.53

3.65 3.38

3.38 3.59

4.38 4.31

4.21 4.13

4.47 4.50

Behavioral Health Benchmark: Bed Size Teaching Hospital

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Structural Empowerment

well-informed we are

Clinical Nurse Coordinate Nursing Grand Rounds

Nursing Certification Rates Continue to Rise

Helen Lee, RN, Cancer Center at Wesley Long Hospital, and Kathleen Kearney, clinical nurse specialist, oncology, along with a committee of support members, coordinate monthly educational offerings for the network. The first Tuesday of every month, Nursing Grand Rounds presents a wide variety of topics for the purpose of educating nurses, and expanding nursing practice and knowledge across the system. Clinical subjects, cyberbullying, animal therapy and community treatment structures are just a few examples of the topics presented.

The number of nurses holding national nursing certification has grown steadily across the network in 2014. Professional nursing certification increases the body of knowledge held by clinical nurses and nurse leaders, positioning Cone Health to deliver the finest nursing care for the community.

The program has enjoyed steady increases in participation, positioning it as a viable option for gaining new information and perspectives on nursing practice.

Participants in Nursing Grand Rounds

600

541

500 398

400 300 200

249

100 2012

10

2013

2014

Percent of Cone Health Nurses Holding National Nursing Certification

34

33.2%

32 30 28

28.8%

29.2%

26 2012

2013

2014

Exemplary Professional Practice

One of the highlights of Nurses Week each year is the celebration of Cone Health’s top 1 percent of nurses – the Nursing Excellence winners. Redesigned in 2012 to follow a blinded selection process, applications for candidates are submitted electronically from anyone in the network.

The application process follows Magnet components in identifying key practices and contributions of excellent nurses and nursing support staff. In 2014, 34 individuals were honored from across the network.

Forensic Nursing Program Hosts Forensic Trends Conference Nurses across the system have access to a Sexual Assault Nurse Examiner (SANE) nurse to provide safe, sensitive and comprehensive care to victims of sexual assault. Cone Health SANE nurses presented the inaugural “Forensic Trends Conference” in 2014 to provide an educational overview of cutting-edge trends and practices when working with victims of violence. The conference drew professionals in law enforcement, crime scene investigation, nursing and medicine as well as students, crisis workers and emergency medical services workers.

Guest speakers discussed gang identification, human trafficking, death investigation processes, street drug trends and Internet predators, and represented the following agencies: • Federal Bureau of Investigation • Homeland Security • Immigration and Customs Enforcement • State of North Carolina Medical Examiner’s Office • Greensboro Police Department • Guilford County Sheriff’s Department • Charlotte-Mecklenburg Police Department

Nancy Sidelinger/News & Record

Cone Health Honors Top Nurses and Nursing Support Staff

Dowd Named Triad Nurse of Distinction One of the most prestigious honors for nursing practice, the Triad Nurse of Distinction, was awarded to Patty Dowd, an Emergency Department nurse at Wesley Long Hospital. Given by the Greensboro News & Record and the N.C. Nurses Association, Dowd was selected from among 10 finalists.

Dowd was cited for providing comfort, compassion and medical care to patients who are experiencing losses. As a nurse with more than 30 years’ experience, she also has a passion for mentoring and coaching the Emergency Department’s newer nurses.

Four other Cone Health nurses were among the finalists: Pam Hicks, RN, Short Stay Unit and Operating Room Holding Area, Moses Cone Hospital; Michelle Toler, RN, intensive care unit nurse, Annie Penn Hospital; and two nurses in Cone Health’s Congregational Nursing Program – Wanda Martin, RN, Salvation Army Center of Hope, and Sharon Muckenfuss, RN, Prince of Peace Lutheran Church. Seventy-eight nurses were nominated for the eighth annual honor, 28 of which were Cone Health nurses. Of the 10 finalists, five were from Cone Health.

The award recognizes registered nurses who make a positive impact on patients and the community, demonstrate value as professional registered nurses, have proven leadership abilities and embody the diversity of the profession.

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Exemplary Professional Practice

EDs Reach Breakthrough Performance The Emergency Department (ED) is the front door to any hospital and often creates the first impressions patients and their families have of the organization. One of the challenges for EDs is the impact of wait time on patient satisfaction.

Using an aggressive “breakthrough” strategy, Cone Health nurses spearheaded an interdisciplinary effort to shorten the length of time that patients spend in the ED. Inpatient RNs, ED RNs, patient placement representatives and administrative coordinators across the system participated in the breakthrough process and redesigned patient throughput.

Creative and innovative strategies were employed for launching the initiative, gathering feedback and addressing issues in real time, bringing attention and energy to the process, and generating a “go live” atmosphere for change across the hospital. The group identified delays and bottlenecks and produced a revised procedure for patient transfer structures and processes. Patient satisfaction scores rose to the highest levels in three years.

Patient perception of emergency care enjoyed a sustained rise since the project’s inception.

Addressing seven categories, setting goals for each and measuring outcomes, the initiative was a success, reducing total ED wait times by 1.93 hours.

ED Breakthrough Project

400 350

Minutes

300

2013 2014

379 334

250 200

180

150

183

157

115

100 50

Goal:

12

110

20 23

6

7

101

128

165

Door to Admission

Door to Bed

ED Bed to Disposition

Disposition to Bed Orders

Bed Request to Bed on Nursing Floor

Door to Discharge 4s and 5s

Door to Discharge

240

15

135

45

45

90

120

Patient Perception of Emergency Care

91 Satisfaction Mean Score

89 87 85

88.2

Goal: 87.8 85.6

84.5

83.8

83 81

83

84.2

85.1 80.9

80.8

79

EMR Initiated

77 Sept 10

Mar 11

Sept 11

Mar 12

Sept 12

84.0

82.1

85.2

85.8

Discharge Calls Initiated

Breakthrough Project Initiated

Mar 13

Sept 13

Mar 14

Sept 14

Cone Health Improvement: 7.3 improvement from Dec. 2012 to Sept. 2014 Average Hospital Yearly Improvement < 0.5/year improvement

pacesetters we are

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Exemplary Professional Practice

Womenâ&#x20AC;&#x2122;s Hospital Increases Breastfeeding Rates Nurses at Womenâ&#x20AC;&#x2122;s Hospital implemented processes that significantly increased breastfeeding initiation and exclusive breastfeeding practices in patients. This preferred method of nutrition for our youngest patients protects from illness, can protect from the development of allergies, may boost intelligence, protects from obesity and lowers the risk of Sudden Infant Death Syndrome.

The Cone Health breastfeeding initiation rates exceed both state and national benchmarks.

Breastfeeding Initiation Rates Compared to Benchmarks

100 80

77%

79%

State Benchmark

National Benchmark

92%

60 40 20 Cone Health Rate

Exclusive Breastfeeding Rates Initiation of Breastfeeding

Percentage of Breastfeeding Patients

100

Exclusive Breastfeeding

90

92 83

80

82

70 60 50 40

43

36

30

48

52

55

20 10 0 FY 2010

14

0

FY 2011

FY 2012

FY 2013

FY 2014

All Inpatient Falls

Inpatient Fall Rates Continue to Drop Thanks to collaborative efforts across the network, inpatient fall rates continue to drop, with the FY 2014 rate showing a dramatic decrease of 42 percent since 2011.

800 700

704

600

541

500

509 407

400 300 200 100 2011

2012

2013

2014

progressive we are

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Exemplary Professional Practice

Nurses Attend International Magnet Conference Cone Health sent 24 nurses to the 2014 International Magnet Conference to celebrate the networkâ&#x20AC;&#x2122;s third Magnet designation. Newly designated and redesignating organizations are recognized in a special celebratory session on the first day of the conference. Held this year in Dallas, Texas, the conference boasted 8,040 attendees, four nationally acclaimed speakers, 135 concurrent sessions on a wide variety of topics, and numerous opportunities for networking, poster review and conversation.

Theresa Brodrick, PhD, RN, CNA, executive vice president and chief nursing officer, and Marjorie Jenkins, PhD, RN, NEA-BC, FACHE, director of Nursing Research, were podium presentation speakers in one of the concurrent sessions. They spoke about the innovative electronic demographic collection system that was designed to accurately

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capture information about Cone Health nurses.

Magnet reporting requires demographic information for each hospital in annual reports submitted to the American Nursesâ&#x20AC;&#x2122; Credentialing Center, the parent organization for Magnet.

New Knowledge, Innovations & Improvements

Nursing Research Council Continues Strong Contributions to Nursing Research The Nursing Research Council (NRC), a Shared Governance body comprised of the director of research; clinical nurse specialists; clinical nurse educators; staff educators; nursing leadership; staff nurses from across our system; faculty from our local universities; librarians and other ad hoc members, continues to provide guidance and inspiration for nursing research in the network.

Advocating and promoting the Iowa Model of Evidence-Based Practice, the NRC assists nurses of all levels in writing proposals, presenting to the Institutional Review Board and examining methodology for their research and evidence-based projects. To aid in this effort, the Council undertook the redesign of the nursing research website. It’s new, user-friendly format archives the journey of nursing research at Cone Health and celebrates research accomplishments. The interactive information on the site provides guidance and support for all investigative nursing activities.

The NRC is the planning body for Cone Health’s Annual Research and Evidence Based Practice Symposium. In its third season in 2014, this year’s event attracted 268 attendees.

The keynote speaker was Courtney H. Lyder, ND, ScD(Hon), FAAN, dean of the UCLA School of Nursing; professor of Nursing, Medicine and Public Health; executive director, UCLA Patient Safety Institute and assistant director of the UCLA Health System.

Cone Health Nursing Science Contributions

Number of Contributions

35 30

29

26

25 20 15 10

12

15

29

18 14

9

13

5 ’12

’13

’14

Publications

’12

’13

’14

Podium Presentations

’12

’13

’14

Poster Presentations

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New Knowledge, Innovations & Improvements

Annie Penn Hospital ICU Hits Infection Prevention Milestone In 2014, the Intensive Care Unit (ICU) at Annie Penn Hospital celebrated eight years of being free of Ventilator-Associated Pneumonia (VAP) infections. Mona Easter, RN, BSN, MBA, NE-BC, vice president of nursing, attributes this success to the departmental team members. As bedside leaders, these nurses hold each other accountable to the VAP bundle, and evidence-based protocol, through direct observation, audit monitoring and eLink observations of practice. They involve the interdisciplinary team in their efforts, particularly respiratory therapists, and they stay aware of goals through progress reports in huddles, department postings of results and in staff meeting discussions.

The secret to this long-standing, successful practice? Consistency. The staff have used the same protocol, with very little variation, for the duration of the eight years. The secret is consistency, compliance and accountability.

The charge nurse ensures monitoring of bundle compliance, and the team members are proud of their results.

They regularly celebrate their continued success.

intentional we are

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Nursing is Change Agent to Reduce Postpartum Hemorrhages Severe bleeding is the number one cause of maternal death worldwide and it is estimated that 75 percent of those deaths are preventable.

A multidisciplinary team led by nurses from Women’s Hospital developed a protocol to improve anticipation, evaluation and management of postpartum hemorrhage (PPH) using evidencebased best practice. Specific goals included: • Risk assessment and anticipation • Enhanced communication between caregivers • Early recognition and management of a PPH event • Standardized response in the event of a PPH • Availability of standard equipment and medications Specific action items in support of the above included:

Postpartum Hemorrhage Rates Women’s Hospital

4.5 4.0

4% 3.5%

3.5 3.0

3.3%

3.1%

2.5 2.0 1.5 1.0 .5 2011

• Development of a risk assessment screening tool in the electronic health record that identifies action items per risk level and generates banner notifications.

• Risk level discussions at Safety Rounds (multiple departments/ multidisciplinary).

• Reference document created with defined stages, roles, considerations, equipment and medications.

• Specific emergency code phone tree created (“Code Hemorrhage”) to alert key personnel in all potentially effected departments and to bring supporting staff assistance at the bedside.

• “Bleeder carts” and PPH medication kits in Pyxis available in all units providing care to postpartum moms.

• Education and simulation training for both Women’s Hospital staff and providers with 98.5 percent participation for birthing suites staff and 87.5 percent participation for all involved staff (over 70 sessions were offered).

• Education and refinement of coding for more accurate data capture.

2012

2013

2013

Postpartum Hemorrhage Protocol Simulation Training

100

98.5%

80

87.5%

60 40 20 Birthing Suites Staff

All Staff and Providers

The protocol was implemented June 2013 with further refinement August 2013 and February 2014. Our PPH rate reported by the National Perinatal Information Center Database (based on coded cases) was 3.3 percent for FY 2013, down from 4.0 percent in FY 2011 and 3.5 percent in FY 2012, and is below the average rate of the database as a whole. Preliminary FY 2014 data reflects coded cases to be down to approximately 3.1 percent (the NPIC database unavailable). Women’s Hospital rate of PPH protocol cases after manual review is at 2.6 percent for FY 2014.

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Our Nurse Executives

20

Theresa Brodrick, PhD, RN, CNA

LaVern Delaney, RN, MSN, MHA/MBA

Executive Vice President & Chief Nursing Officer

VP, Nursing /Patient Services Alamance Regional Medical Center

Anne Brown, RN, MSN, PCCN

Mona Easter, RN, BSN, MBA

Director, Nursing/Patient Services Wesley Long Hospital

Vice President, Nursing/Patient Services Annie Penn Hospital

Dennis Campbell, RN, MS, BSN, NEA-BC

Waqiah Ellis, RN, MSN, NE-BC

Vice President, Behavioral Health Services

Director, Nursing/Patient Services Moses Cone Hospital

Catherine A. Cochran, RN, MSN, NEA-BC

Debbie Grant, RN, MSN, CENP

Executive Director Clinical Informatics

Vice President, Nursing Practice, Education and Community Outreach

first rate we are

Carol Harris, RN, MHA, NE-BC, CCRN Director, Nursing/Patient Services Alamance Regional Medical Center

Karin Henderson, RN, MSN, CENP

Sue Pedaline, DNP, RNC, MS

Executive Director Organizational Integration

Vice President, Nursing/Patient Services Womenâ&#x20AC;&#x2122;s Hospital

Joan LoPresti, RN, MS, BSN, NEA-BC

Cheryl Somers, RN, MSN, NEA-BC

Director, Nursing/Patient Services, MedSurg Service, Moses Cone Hospital

Executive Director, Emergency Services

Annette Osborne, RN, MSN

Youland Williams, RN, MSN, NEA-BC

Vice President, Nursing/Patient Services Moses Cone Hospital

Vice President, Nursing/Patient Services Wesley Long Hospital

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About Us

1

2

Cone Health is a not-for-profit network of health care providers serving people in Guilford, Forsyth, Rockingham, Alamance, Randolph, Caswell and surrounding counties.

Our tagline – “The Network for Exceptional Care” – highlights our commitment to excellence, which is shared by our more than 11,000 employees, 1,300 physicians and 1,200 volunteers.

As one of the region’s largest and most comprehensive health networks, Cone Health has more than 100 locations, including six hospitals, three ambulatory care centers, three outpatient surgical centers, four urgent care centers, a retirement community, more than 75 physician practice sites and multiple centers of excellence.

1 • Alamance Regional Medical Center, a 238bed medical and surgical hospital in Alamance County, joined Cone Health in May 2013. Specialized services include heart and vascular, cancer and women’s care as well as advanced imaging services and surgical services, among others. Our modern facility utilizes cutting-edge equipment such as the da Vinci® surgical robot system.

2 • Annie Penn Hospital has 110 acute care beds. This facility includes inpatient and short stay surgery centers, cancer care, heart care and specialty clinics such as a Sleep Disorders Center and an Endoscopy Center of Excellence.

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4

3

3 • Behavioral Health Hospital offers pediatric and adult inpatient crisis stabilization at an 80-bed facility.

Outpatient care includes numerous group therapy programs as well as individual counseling and day programs. The hospital also offers the community a 24hour Helpline that provides access to a trained professional.

Three additional outpatient Behavioral Health Centers are located in Greensboro, Kernersville and Reidsville.

4 • Cone Health Medical Group is a physician-lead network of specialty and primary care medical practices of more than 400 doctors and health care professionals at nearly 100 locations across the Triad. Cone Health Medical Group providers offer primary care medical services, including family medicine, internal medicine, obstetrics and gynecology, pediatrics and urgent care. Specialty care – such as cardiology, gastroenterology, pulmonology, rheumatology, oncology, endocrinology, urology and general surgery – is also available at many locations.

5 • MedCenter High Point is a 75,000-square-foot facility that features a 24-hour emergency department; comprehensive lab and imaging services; an outpatient pharmacy; Women’s Health Network; specialized health services such as outpatient rehabilitation, cancer care, heart care and sports medicine; and other walk-in services.

5

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6 • MedCenter Kernersville offers a full range of services, including family medicine, women’s health care, orthopedics, heart care, outpatient rehabilitation, behavioral health, and occupational health complete with an on-site lab and imaging services. For those seeking immediate care, we offer an urgent care facility that is open seven days a week with minimal wait times.

7 • MedCenter Mebane offers numerous services in a single location, including an outpatient surgery center; urgent, primary and cancer care; and services in the areas of ear, nose and throat, gastroenterology, imaging, radiology, lab, physical therapy, diabetes management, nutrition therapy, occupational health, ophthalmology/optometry, dermatology and plastic surgery.

8 • The Moses H. Cone Memorial Hospital is our flagship. Moses Cone Hospital is a 536-bed teaching hospital and referral center. It includes a Children’s Emergency Department, Level II Trauma Center and centers of excellence in orthopedics, neurosciences, stroke, and heart and vascular care. North Tower opened in 2013 with 16 new operating rooms and all private patient rooms.

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9 • Triad HealthCare Network is one of the nation’s most successful accountable care organizations. Cone Health partnered with local physicians to create this consortium of more than 700 physicians in Guilford, Rockingham, Randolph and Alamance counties. Those physicians have come together to demonstrate how collaboration will allow them to markedly improve the quality and value of the care provided to patients.

10 • Wesley Long Hospital offers 175 private beds for oncology, bariatric, urology and orthopedics medical and surgical patients. Our modern facility utilizes state-of-theart equipment such as the da Vinci® surgical robot system and the SpyGlass® visualization system in the Endoscopy Center. The campus also provides cancer, sickle cell, sleep disorders, and wound and hyperbaric care.

11 • Women’s Hospital, a 134-bed facility, is home to one of the area’s most experienced neonatal intensive care teams. The hospital’s Level II and Level III unit has been providing care to critically ill newborns since 1990. The hospital also houses the nationally accredited Breast and Ultrasound Imaging Center. The hospital’s da Vinci® robot provides minimally invasive surgical care for gynecology patients.

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cone health nurses we are

Cone Health | 1200 N. Elm St. | Greensboro, NC 27401 | conehealth.com